Open Disclosure Statewide Pilot Project - Evaluation report 2007

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Introduction

Patients expect to be fully informed about the care they receive, particularly when things don’t go according to plan. Open disclosure (OD) is the name given to the process of communicating with patients and their families when things have gone wrong.

In 2002 the Australian Council for the Safety and Quality in Health Care (now the Australian Commission on Safety and Quality in Health Care) developed the National standard on open disclosure. The Australian Health Ministers’ Conference endorsed the standard in July 2003.

Although various strategies have been used to implement OD in the past, the standard outlines clear and consistent processes including:

• an apology or expression of regret
• a factual explanation of what occurred, including actual and potential consequences
• the steps being taken to manage the event and prevent its recurrence.

While initial concern has been expressed about the legal implications of OD, there is consensus that the principle of disclosing adverse events openly is sound and considered best practice. The emphasis has been on how it is implemented and those elements that support or hinder its application within health services.

The Department of Human Services provided funding to 12 Victorian public health care facilities to pilot the implementation of the OD standard within their organisations. These included both metropolitan and rural and regional sites to ensure a good cross-section of health services.

Across Australia there are currently 42 sites participating in a national OD evaluation. Key lessons from the national evaluation are expected in late 2007. This report documents the state-based evaluation undertaken as part of the national project.

The OD framework outlined in the standard promotes a system where staff are supported and encouraged to identify and discuss adverse events as they occur with patients and their families, and is focussed on identifying opportunities for system improvements.

While many health services and clinicians already practise OD in various formats, the pilot provided an opportunity to implement a standard approach and framework to ensure effective communication following adverse events.

The objectives of the evaluation were to determine the organisational, cultural and structural features that support, or hinder, the implementation of OD in hospitals, thereby identifying the barriers and enablers.

The methodology for this evaluation included:

• reviewing the implementation process for open disclosure at each pilot site
• surveying staff involved in the disclosure process from pilot sites
• a limited survey of patients and families/carers involved in the disclosure process.

This evaluation will inform future implementation by making recommendations that will require consideration and action prior to ongoing statewide implementation. Consideration will also be given to the findings of the national evaluation report when it becomes available.

Key findings from the evaluation show that:

• open disclosure is not a new concept; many clinicians incorporate this into their current practice, though there was no consistent way of managing this process
• there was no standardised approach to the disclosure process within all pilot sites involved
• education and training were key elements to successful implementation
• where there was a strong culture of quality and safety reporting, this process was more readily adopted
• the disclosure process complements the clinical risk management strategies used in Victorian hospitals
• where this process was integrated into the organisation’s clinical risk management framework/policy there was greater awareness and uptake
• documentation of discussions with the patient/family was overall poor and this raised medico-legal concerns regarding the content of discussions and where these were documented
• some patients and their families did not wish to engage in this process
• the language was felt to be suspicious and negative in its connotation, most sites rephrased the language to fit their clinical risk or governance framework.

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